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Biomedical subjects

N Loberant

Publications and source records attributed to N Loberant.

At least 19 recordsLinked to original sources
PubMed2001

The laparoscopic approach to abdominal hydatid cysts: a prospective nonselective study using the isolated hypobaric technique.

HYPOTHESIS: The laparoscopic isolated hypobaric technique that we developed and use is safe and feasible for almost all kinds of hepatic and extrahepatic abdominal hydatid cysts. DESIGN: A case series. PATIENTS: Between August 1992 and December 1999, 31 patients with no selection criteria underwent 32 consecutive laparoscopic operations for 52 symptomatic hydatid cysts located in the liver (49), spleen (1), and pelvis (2). Eleven patients underwent surgery for between 2 to 5 cysts. INTERVENTIONS: The main surgical maneuvers (puncture, parasite neutralization, and complete evacuation) were performed through an assembled transparent cannula, in which a vacuum was created, while its tip adhered firmly to the cyst wall. Following evacuation of the cyst contents, we attempted to perform partial pericystectomy, omentoplasty, and closed-suction drainage. MAIN OUTCOME MEASURES: Surgical complications and postoperative disease recurrence. RESULTS: Mean cyst diameter was 8.4 cm (range, 3.5-25 cm). Seven cysts were subdiaphragmatic, and 6 were on the posterior (hidden) aspect of the liver. Mean postoperative follow-up was 49 months. Forty-one cysts contained live parasites, and 11 were secondarily infected. Twenty-four cysts were complex. Perioperative complications occurred in 5 patients, including 1 patient who died 1 month after surgery owing to Candida sepsis. Mean hospital stay was 6 days. No evidence of recurrence was recorded during follow-up. CONCLUSIONS: The isolated hypobaric laparoscopic technique described provides a safe and efficacious approach to almost all types of abdominal hydatid cysts and takes advantage of the recognized benefits of the laparoscopic approach.

Adolescent↗
PubMed2001

Cytological diagnosis of primary leiomyosarcoma of bone: case report.

We report on a case of primary leiomyosarcoma of the bone in a 77-yr-old man. The patient presented with a painful, enlarging mass in the left shoulder of 6 mo duration. Radiography and computed tomography (CT) revealed a large destructive intramedullary lesion of the proximal humerus, with massive extension into the surrounding soft tissues. CT-guided fine-needle aspiration biopsies (FNAB) of both the bony and soft-tissue lesions were performed. Cytological examination showed a neoplastic process composed of spindle cells mixed with pleomorphic cells. The smooth muscle origin of the neoplastic cells was confirmed by immunocytochemical analysis. We describe the cytological features of this rare primary tumor of bone, and consider the differential diagnosis of spindle-cell neoplasms.

Aged↗
PubMed2000

Pelvic actinomycosis presenting as ureteric and rectal stricture.

BACKGROUND/AIMS: Simultaneous ureteric and rectal stricture due to pelvic actinomycosis is very rare and only a few cases of either rectal or ureteric stricture have been reported. Our aim is to report a case of stricture of the rectum and the right ureter due to pelvic actinomycosis infection in a 63-year-old man. METHODS: Explorative laparotomy and biopsies of the inflammatory pelvic mass were the only procedures that led to the definitive diagnosis of actinomycosis. Temporary diverting colostomy, drainage of the right ureter by a pigtail catheter and postoperative treatment with appropriate antibiotics were successful in eradicating the inflammatory process. CONCLUSIONS: Extensive pelvic masses involving pelvic viscera should be biopsied before undertaking any major surgery because of the possibility of pelvic actinomycosis.

Actinomycosis↗
PubMed2000

Distal arterial flow in patients undergoing upper extremity dialysis shunting: a prospective study using doppler sonography.

OBJECTIVE: The objective of this study was to document changes in the distal circulation after creation of a proximal upper extremity dialysis shunt and to correlate these findings with the patient's clinical condition. SUBJECTS AND METHODS: We prospectively examined 18 patients scheduled for upper extremity shunt creation. We used color and spectral Doppler sonography to examine flow in the radial and ulnar arteries, noting flow direction and peak systolic velocity. After the shunt procedure, we repeated the measurements and correlated them statistically with hand symptomatology. RESULTS: Six (33%) of 18 patients were symptomatic. The mean peak systolic velocities in the radial and ulnar arteries were 52 and 61 cm/sec, respectively, before surgery, and decreased to 12 cm/sec after surgery in the radial artery and 44 cm/sec in the ulnar artery. The mean percentage of decrease in peak systolic velocity was 77% in the radial artery and 28% in the ulnar artery. Eight patients showed reversed flow. No statistical correlation was found between change in peak systolic velocity values before and after surgery and the presence of hand symptoms. Similarly, no correlation was found between flow reversal and symptoms. The most consistent factor associated with symptoms was diabetes; all symptomatic patients were diabetic, but only 54% of the diabetic patients were symptomatic. CONCLUSION: The difference in the peak systolic velocities in the radial and ulnar arteries after shunt construction does not correlate with symptoms. The hand can tolerate a significant decrease in the peak systolic velocity and even flow reversal without symptomatology.

Adult↗
PubMed1999

Rhabdomyosarcoma in a child with massive pleural effusion: cytological diagnosis from pleural fluid.

We report on a case of embryonal rhabdomyosarcoma in an 11-yr-old boy investigated for mild chest pain after trauma. Chest radiography showed a massive right pleural effusion. Cytological analysis of the pleural fluid demonstrated the presence of malignant small undifferentiated cells. The rhabdomyoblastic nature of the cells was confirmed by positive immunostains of HHf35 actin, desmin, and skeletal muscle myosin; histological examination of a core biopsy confirmed the diagnosis of rhabdomyosarcoma. Computed tomography and gallium scan revealed the presence of an extensive anterior and lower chest wall mass involving the mediastinum, as well as retroperitoneal lymphadenopathy. Massive pleural effusion is a frequent presentation in malignant disease, but is rare in rhabdomyosarcoma. The immunochemical stain studies performed on cytological smears in this case proved to be very useful for making the definitive and accurate diagnosis. Diagn. Cytopathol. 1999;21:125-128.

Child↗
PubMed1999

Papillary cystic neoplasm of the pancreas in a teenage boy.

We present a case of a 13-year-old boy with a left-sided abdominal mass which proved to be a papillary cystic neoplasm of the pancreas. This low-grade malignant lesion of young patients is very rare, and exceedingly rare in males. The prognosis following resection of this tumor is good. We present the ultrasound and computed tomographic picture of this lesion, as well as the gross and microscopic pathology.

Adolescent↗
PubMed1999

Closure of the ductus venosus in premature infants: findings on real-time gray-scale, color-flow Doppler, and duplex Doppler sonography.

OBJECTIVE: Our objective was to use gray-scale, color-flow, and duplex Doppler sonography to study the anatomy, flow pattern, and time of closure of the ductus venosus in healthy premature infants. SUBJECTS AND METHODS: We prospectively examined the ductus venosus in 130 premature infants whom we divided into two groups: Group I comprised 27 neonates of gestational age 28-32 weeks, and group II comprised 103 neonates of gestational age 33-36 weeks. Neonates who had undergone umbilical vessel manipulation were excluded from the study. All examinations included gray-scale, color-flow, and duplex Doppler sonography. Patency, length, color flow, and Doppler characteristics of the ductus venosus were recorded. Neonates were examined 1-2 days after birth, 6-7 days after birth, and subsequently every 3-4 days until ductus closure was observed. The time of closure of the ductus for the two groups was compared using the chi-square test. RESULTS: The ductus venosus was patent during the initial examination in 128 of the 130 neonates. Doppler waveform was venous with little variation in velocity. Ductus length slightly exceeded 1 cm in both groups. We found a statistically significant difference in the percentage of infants having a patent ductus venosus after the initial examination: At 1 week after birth, ductus patency was shown in 85% of the infants in group I and in 56% of the infants in group II; at 2 weeks, the respective percentages were 42% and 14%; and at 3 weeks, 27% and 0%. CONCLUSION: The ductus venosus is patent 1-2 days after birth in virtually all premature infants. From 6 days after birth and onward, a significantly greater percentage of smaller premature infants (i.e., 28-32 weeks' gestational age) have a patent ductus venosus than do larger premature infants (i.e., 33-36 weeks' gestational age).

Blood Flow Velocity↗
PubMed1998

[Miliary and reticulo-nodular pulmonary brucellosis].

Brucellosis is a classical zoonosis caused by a Gram-negative bacillus of the genus Brucella. Human brucellosis can either be acute or chronic and present with a variety of manifestations, mostly with fever and signs of musculo-skeletal involvement. It may be complicated by involvement of the cardiovascular, central nervous or genito-urinary systems. However, pulmonary brucellosis is a rare complication. We report a case of miliary and reticulo-nodular brucellar pneumonia with positive blood and sputum cultures and positive serological tests. To the best of our knowledge this is the first case to be reported from Israel of miliary pneumonia with sputum positive for brucellosis.

Adult↗
PubMed1997

Enteropathy-associated T-cell lymphoma: a case report with radiographic and computed tomography appearance.

We report a case of enteropathy-associated T-cell lymphoma (EATL) of the jejunum in a 56-year-old man. The patient suffered for several years from nonspecific abdominal complaints, with no clinical evidence of malabsorption. The patient underwent extensive imaging procedures including barium meal and computed tomography. Computed tomography of the abdomen showed small mesenteric lymph nodes and an area of intestinal wall thickening. Barium meal demonstrated a short jejunal stricture. Histology revealed lymphoma of the jejunum, with microscopic changes distant from the lesion consistent with celiac disease. The spectrum of EATL ranges from patients with frank celiac disease, to patients with only immunohistochemical evidence of celiac disease, who develop small bowel lymphoma.

Celiac Disease↗
PubMed1997

Posttraumatic intestinal stenosis: radiographic and sonographic appearance.

We report a case of posttraumatic intestinal stenosis (PIS), an uncommon sequela of blunt abdominal trauma, in which injury to the mesentery and bowel wall results in later focal ischemic stricture of that segment. We include CT images at the time of trauma, and barium meal and abdominal sonography obtained during the subsequent admission. Examination of the resected bowel loop showed transmural infarct and posttraumatic changes in the adjacent peritoneal fat. This is the first report which includes both imaging at the time of trauma and sonographic appearance of the narrowed bowel loop. Posttraumatic intestinal stenosis should be considered in the differential diagnosis of a narrowed bowel loop in a patient with a history of blunt abdominal trauma.

Abdominal Injuries↗
PubMed1996

A prospective study evaluating the usefulness of continuous supplemental oxygen in various endoscopic procedures.

The influence of oxygen supplementation on the prevalence of hypoxemia during endoscopic procedures was studied in 289 patients in a prospective clinical trial. The frequency of oxygen desaturation was found to decrease significantly in patients receiving oxygen via nasal prongs, compared to patients not receiving oxygen supplementation. The effect was demonstrated especially in patients who underwent an additional procedure during their endoscopic examinations. Similar effects were found in patients undergoing gastroscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography. In view of the risks related to hypoxemia and its high prevalence in endoscopic procedures (28-50%) we recommend that a routine oxygen supplementation policy be considered in every patient undergoing endoscopy, especially when additional procedures are to be performed.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

Renal hydatid cyst: urinary cytological diagnosis.

Echinococcal disease is endemic in many areas of Asia, Europe, South America, the Near East, Australia, and New Zealand. Hepatic and pulmonary cysts are the most common presentation. Isolated renal hydatid cyst is an uncommon presentation of echinococcal disease, since renal involvement occurs in only 2-3% of cases. We present the case of a young man with renal colic, in whom the diagnosis of renal hydatid disease was established cytologically. Urine cytology, performed because of persistent hematuria, revealed scolices of Echinococcus granulosus and prompted further imaging investigation, and, ultimately, surgical treatment.

Adult↗
PubMed1995

Oxyphil cell carcinoma of the parathyroid: a rare cause of hyperparathyroidism.

Oxyphil carcinoma of the parathyroid is an extremely rare tumour, only two previous patients having been reported. We report a 55-year-old woman with this condition, who presented with a picture of hyperparathyroidism, including hypercalcaemia, hypercalciuria, hypophosphataemia, increased alkaline phosphatase, and bony lesions. Biopsy of a bone lesion was consistent with brown tumour. Fine needle aspiration cytology and subsequent operative histology of the parathyroid lesion showed an oxyphil cell tumour with malignant characteristics. Following excision, the patient made a good recovery, complicated only by postoperative hypocalcaemia.

Adenocarcinoma↗
PubMed1995

Acute focal bacterial nephritis in childhood brucellosis.

Brucellosis is an infectious disease transmitted from various animal hosts to man. In children the most common route of infection is unpasteurized milk or milk products. Brucellosis affects the urinary tract uncommonly, most frequently causing orchioepididymitis. We report the case of a 4-year-old boy with brucellosis who developed acute focal bacterial nephritis (AFBN), documented by sonography, gallium scan, and computed tomography. After appropriate treatment his symptoms and his sonographic abnormality resolved completely. To the best of our knowledge, this is the first report of the association of AFBN and brucellosis.

Acute Disease↗
PubMed1994

Laparoscopic treatment of hydatid cyst of the liver: initial experience with a small series of patients.

A laparoscopic technique to manage hydatid cyst of the liver is described. The technique is safe and simple and has the advantages of other abdominal laparoscopic operations. It also fulfills the prerequisite of open surgery of hydatid cyst of the liver, namely, the prevention of intraperitoneal spillage of cyst contents. Our technique enables treatment of the residual cyst cavity following aspiration of contents. In the past 15 months, 10 cysts (5-17 cm in diameter) in 6 patients were managed successfully using this approach, with no mortality or short-term recurrence.

Adult↗